Learning Objectives: Describe how three smoking moms were able to make changes to the environmental tobacco smoke exposure their children received and how they attempted to quit smoking during a 14-session counseling intervention.

Abstract: The Healthy Tots Project is an intervention designed to reduce environmental tobacco smoke exposure (ETS) to young children and to reduce parents’ smoking among low-income families recruited from the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The study combines 14 counseling sessions for ETS reduction and smoking cessation with nicotine replacement therapy. One hundred and fifty families (with a mother who exposes her non-breastfeeding child under age four to a minimum of three cigarettes per day) will be recruited. Families are assigned at random to experimental/counseling group or “usual care” control group. Families in the experimental group receive ten in-home and four telephone counseling sessions over six to eight months. Counseling is provided to all mothers in the experimental group. Other household members are also encouraged to participate. Counseling incorporates contracting, shaping, and problem-solving negotiations. The three case studies presented will demonstrate how the goal setting and change process occurs over the counseling program. Short-term goal failures and attainments illustrate the challenges facing both counselors and smokers trying to reduce children’s ETS exposure and attempting smoking cessation. The life events that these mothers are experiencing concurrent with the intervention will also be described, since they exemplify the struggles that this subpopulation of WIC are experiencing. If effective, this intervention could be provided by WIC clinics. Controlled analyses will determine the efficacy of these procedures, but the length of counseling might best be tailored to the needs of the individual smoker/family.